Wednesday, May 25, 2011

Fiction, particularly the thriller genres, generally require a character to sustain an injury. These can run the gamut from minor to life-threatening.

Today, I'm going to focus on a couple of general guidelines if you injure a character with some type of fracture.

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Though it may be hard to break a bone, sometimes it seems the most minor accidents can cause a fracture. My mother once slipped off a small rock onto the side of her foot. Her foot was bruised and mildly swollen and in my nursing wisdom (I was only in nursing school at the time), I said, "There's no way you broke it slipping sideways off a rock." Needless to say I was wrong. Yes, broken foot.

Guideline #1: The amount of swelling is not indicative of fracture. Ankle injuries are classic for this. Patients come in with a horribly swollen ankle, convinced they broke it. My guess in the pediatric realm (up to age 21), the ankle is 95% of the time sprained and not broken. Arms that have an obvious deformity and you can see the limb is broken before you get an x-ray, have little swelling in comparison.

Guideline #2: If something is broken, generally the joint above and below will need to be immobilized (or very close to the next joint). Someone asked me once if a person broke one bone in their lower leg, could they drive? There are two bones in the lower leg: the tibula and the fibula. Depending on how close the fracture is to the knee, the ankle and knee will have to be immobilized. I don't know how many people can drive with a straight leg.

Guideline #3: Splints are placed first. It is rare to put a cast on in the emergency department. The reason splints are placed first is to allow for swelling to come and go. A splint is generally fiberglass sheets secured in place with an ace wrap. This allows for expansion during swelling. Then in 7-10 days, the patient is referred to an orthopedic doctor for cast placement.

Guideline #4: A good rule is that a cast will be in place for 6-8 weeks. Now, this is highly variable and if an author said the cast needed to stay in place for nine weeks, it probably wouldn't drive me nuts enough to go check it out. However, a cast on for two weeks is unlikely. You should consider this guideline because it will effect your character for that length of time and inhibit their mobility. Maybe, this is something you want as the author.

Guideline #5: My observation: these bones/joints have a higher incidence of requiring surgery: ankle, elbow, and femur. Now, you can make any fracture bad enough to require surgery but these ones can be more common to require the OR.

My hero broke his fibula a few inches above the ankle. This is a historical and a book from the period said it should heal in 4-5 weeks, so I used five. I didn't mention swelling, specifically, and don't really need to, but would there have been any substantial swelling in this case?

From my personal ER experience, a simple fracuture to the lower leg typically has some mild swelling and pinpoint tenderness. Patients typically won't want to bear weight. This is unlike the ankle which swells up impressively even with simple injury at times.

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Disclaimer

The medical information presented on this blog is for writers to use in their works of fiction. If a medical question is submitted, it is assumed that it is for a current work of fiction and not related to an actual person’s medical problem. Consult a licensed physician for specific information, advice and treatment related to a medical condition.